Tomashefski J F, Cohen A M, Doershuk C F
Department of Pathology, Cleveland Metropolitan General Hospital, OH 44109.
Hum Pathol. 1988 May;19(5):555-61. doi: 10.1016/s0046-8177(88)80204-1.
We used light microscopy to examine, at autopsy, bronchial arteries in three patients with cystic fibrosis who died, respectively, 10, 16, and 28 months after bronchial artery embolization with barium sulfate-impregnated polyvinyl alcohol (PVA) to control hemoptysis. PVA was not identified beyond the midsegmental bronchus in any patient. Persistent focal fibrovascular occlusion was noted in two patients, and recanalized and/or partially obstructed vessels were associated with PVA in all. The histologic reaction to PVA included fibrosis, mild chronic inflammation, localized foreign body reaction, and, in two patients, focal calcification of PVA spicules. Within the inflammatory milieu were numerous macrophages containing BaSO4. Extensive vascular mural destruction and fibrosis associated with PVA were also observed. Both PVA and BaSO4 were also frequently present in the perivascular connective tissue. These findings indicate that, although longterm occlusion persists after therapeutic arterial embolization with PVA, focal recanalization also occurs. The extent of vascular mural injury following PVA embolization in humans has been previously underestimated by animal experiments. Finally, perivascular deposition of PVA represents a common reaction to diverse foreign body emboli in both systemic and pulmonary arteries.
我们运用光学显微镜，在尸检时检查了三名囊性纤维化患者的支气管动脉。这三名患者分别在使用硫酸钡浸渍的聚乙烯醇（PVA）进行支气管动脉栓塞以控制咯血后10个月、16个月和28个月死亡。在任何患者中，均未在节段性支气管中段以外发现PVA。两名患者出现持续性局灶性纤维血管闭塞，所有患者中均发现再通和/或部分阻塞的血管与PVA有关。对PVA的组织学反应包括纤维化、轻度慢性炎症、局部异物反应，在两名患者中还出现了PVA针状结晶的局灶性钙化。在炎症环境中，有许多含有硫酸钡的巨噬细胞。还观察到与PVA相关的广泛血管壁破坏和纤维化。PVA和硫酸钡也经常出现在血管周围结缔组织中。这些发现表明，尽管用PVA进行治疗性动脉栓塞后长期闭塞持续存在，但也会发生局灶性再通。动物实验此前低估了人类PVA栓塞后血管壁损伤的程度。最后，PVA在血管周围的沉积代表了对全身和肺动脉中各种异物栓子的常见反应。
